Advancements in Trichuris trichiura treatment and diagnosis in children: Assessing high-dose ivermectin, benzimidazoles and diagnostic techniques

Abstract

Introduction Approximately 350 million people are currently infected with Trichuris trichiura. The WHO recommends mass drug administration (MDA) with benzimidazole (BZ) as the main control strategy, however, these drugs have demonstrated a reduced efficacy against T. trichiura infections. The current strategy is, therefore, not suitable for achieving the recently established goal of eliminating STH as a public health problem by 2030. Administration of combination treatment with broad-spectrum anthelminthic drugs such as IVM has been recommended. Objective The aim of this thesis was to investigate the advancements in T. trichiura treatment and diagnosis. First, by conducting an RCT comparing experimental multiple-day, and high-dose IVM drug combinations against ALB monotherapy. Followed by performing a rapid systematic review and meta-analysis to update the current knowledge on the efficacy and safety of IVM administration against trichuriasis in children. Lastly, comparing the performance of RT-qPCR vs. Kato-Katz, to determine their performance in a context of reduced transmission due to treatment intervention. Methods The randomized clinical trial was performed in northern Honduras. Efficacy was measured 14-21 days post-treatment through egg reduction rate (ERR) and cure rate (CR). Safety was evaluated by analyzing the frequency and severity of adverse events. A rapid review of evidence was conducted in 5 databases, to explore the literature results with respect to efficacy and safety of IVM against trichuriasis. Finally, two diagnostic techniques were evaluated to determine their performance after treatment intervention. Results All the experimental arms containing IVM resulted in significantly higher efficacy compared to the standard of treatment. The combination of ALB and high dose IVM demonstrated an excellent safety profile. The rapid systematic review confirmed the superiority of BZ+IVM combination. The two diagnostic techniques resulted in an almost perfect agreement, in a setting decreasing burden. Conclusions These results provide high-quality data contributing to the available body of knowledge related to the challenges faced by the global efforts of STH control, emphasizing in T. trichiura.